Injuring the knee is one of the most common general and sporting injuries and can give long-term problems with pain, stability and functional activities. Physios begin with the subjective examination, asking about the cause of the injury, the amount of force involved, whether the knee swelled up quickly or the knee was unstable afterwards and the person found it difficult to weight bear.
The amount of pain a patient suffers indicates the severity of the injury involved and the particular location of the pain can point to which anatomical structures have been injured. As the knee will be very difficult to walk on in the presence of a fracture these injuries are rarely missed in diagnosis. During the examination the physiotherapist will test the knee structures to look for the cause of the injury.
Objective Examination of the Knee
The physiotherapist will look at the knee and check for effusion by observation or doing the patellar tap test. The knee can swell greatly and be very tight, needing aspiration by a needle. How well the knee can move when not weight bearing is assessed by the physio. Knee extension is the movement of straightening the knee out and flexion is bending the knee. The knee does have a certain degree of rotation but that is rarely checked in the initial period.
The reaction to examination testing indicates how the treatment plan should proceed. The pain level, ease of joint movement and reaction to tests are included in this assessment. The patient moves the joint actively with the physiotherapist adding passive movement to test the joint further. The power of the main antigravity muscles, the hamstrings and quadriceps, are tested by manually resisting the knee movements or asking the patient to perform weight bearing movements.
Manual testing of the knee ligaments by the physiotherapist tells him or her about these important stability structures. The physio levers the knee inwards and outwards to test the medial ligament and the lateral ligament (the collateral ligaments) and pulls the shin bone back and forward to test the anterior cruciate ligament and the posterior cruciate ligament. Manual palpation around the joint and adjacent structures can help indicate which structure has been injured.
Physiotherapy treatment of the injured knee
The PRICE technique is used by physiotherapists to manage acutely painful joints, with a brace used to protect the joint in the presence of instability. Walking aids may be needed to reduce the stresses through the joint and to encourage a good walking pattern. Rest is essential in settling an inflamed joint and the I in PRICE stands for ice treatment, packs or cold water compress applied to the joint to reduce pain, inflammation and swelling. This and a compression splint can reduce pain, increase range of movement and allow treatment progression.
A reduction in swelling and pain allows the physiotherapist to give exercises to improve the knee's ranges of movement and strength. The largest and most powerful muscles are the quadriceps and the hamstrings. The quadriceps allows knee power for getting up from sitting, going up and down stairs and walking, keeping the knee stable. After the knee copes with exercise on the plinth the physio will move to exercises in weight-bearing and in more active activities.
The ability to sense the position of our joints is a vital part of normal joint function. The brain constantly checks the position of the knee and coordinates the pattern of muscle response to prevent dangerous postures. Balance work such as standing on one leg and progressing to working with balance on an unstable wobble board is started. Balance and coordination are practiced until the knee can manage rough ground and dynamic activities such as running and jumping. Good movements with a small amount or no pain, good strength and balance with normal walking mean that the knee has recovered. - 15437
The amount of pain a patient suffers indicates the severity of the injury involved and the particular location of the pain can point to which anatomical structures have been injured. As the knee will be very difficult to walk on in the presence of a fracture these injuries are rarely missed in diagnosis. During the examination the physiotherapist will test the knee structures to look for the cause of the injury.
Objective Examination of the Knee
The physiotherapist will look at the knee and check for effusion by observation or doing the patellar tap test. The knee can swell greatly and be very tight, needing aspiration by a needle. How well the knee can move when not weight bearing is assessed by the physio. Knee extension is the movement of straightening the knee out and flexion is bending the knee. The knee does have a certain degree of rotation but that is rarely checked in the initial period.
The reaction to examination testing indicates how the treatment plan should proceed. The pain level, ease of joint movement and reaction to tests are included in this assessment. The patient moves the joint actively with the physiotherapist adding passive movement to test the joint further. The power of the main antigravity muscles, the hamstrings and quadriceps, are tested by manually resisting the knee movements or asking the patient to perform weight bearing movements.
Manual testing of the knee ligaments by the physiotherapist tells him or her about these important stability structures. The physio levers the knee inwards and outwards to test the medial ligament and the lateral ligament (the collateral ligaments) and pulls the shin bone back and forward to test the anterior cruciate ligament and the posterior cruciate ligament. Manual palpation around the joint and adjacent structures can help indicate which structure has been injured.
Physiotherapy treatment of the injured knee
The PRICE technique is used by physiotherapists to manage acutely painful joints, with a brace used to protect the joint in the presence of instability. Walking aids may be needed to reduce the stresses through the joint and to encourage a good walking pattern. Rest is essential in settling an inflamed joint and the I in PRICE stands for ice treatment, packs or cold water compress applied to the joint to reduce pain, inflammation and swelling. This and a compression splint can reduce pain, increase range of movement and allow treatment progression.
A reduction in swelling and pain allows the physiotherapist to give exercises to improve the knee's ranges of movement and strength. The largest and most powerful muscles are the quadriceps and the hamstrings. The quadriceps allows knee power for getting up from sitting, going up and down stairs and walking, keeping the knee stable. After the knee copes with exercise on the plinth the physio will move to exercises in weight-bearing and in more active activities.
The ability to sense the position of our joints is a vital part of normal joint function. The brain constantly checks the position of the knee and coordinates the pattern of muscle response to prevent dangerous postures. Balance work such as standing on one leg and progressing to working with balance on an unstable wobble board is started. Balance and coordination are practiced until the knee can manage rough ground and dynamic activities such as running and jumping. Good movements with a small amount or no pain, good strength and balance with normal walking mean that the knee has recovered. - 15437
About the Author:
Jonathan Blood Smythis a Superintendent Physiotherapist at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for Physiotherapists in Kensington.
